婴幼儿白内障合并玻璃体异常的临床特点和病因分析

发布时间：2018-10-16 10:42

【摘要】：目的探讨婴幼儿白内障合并玻璃体异常的临床特点和病因。设计回顾性、非对照病例研究。研究对象84例(114眼)3岁以下眼部彩色多普勒超声检查提示玻璃体异常的婴幼儿白内障患儿。方法回顾性总结2013年1月至2014年7月在北京同仁医院眼科接受手术治疗的3岁以下合并玻璃体异常的婴幼儿白内障患儿。记录患儿月龄、主诉、体征、超声检查及超声诊断、术后确定诊断、既往史、家族史和母亲孕产史,对婴幼儿白内障合并玻璃体异常的病因和临床特点进行分析。主要指标月龄、症状、病程、体征、超声表现及超声诊断、确定诊断。结果在84例(114眼)患儿中,发病月龄0~15个月,平均(2.7±3.0)个月,确诊月龄2~20个月,平均(7.8±4.2)个月。81例(96.4%)为家长发现异常,3例(3.6%)为体检查出异常。主要首发症状为白瞳39例(46.4%),不追物16例(19.0%),斜视10例(11.9%),双眼不等大7例(8.3%)。白内障表现为全白内障75眼(65.8%),后极性白内障38眼(33.3%),膜性白内障1眼(0.9%),可伴有眼球震颤、斜视、小眼球、浅前房、继发性青光眼、瞳孔残膜、牵拉性视网膜脱离、脉络膜缺损等。超声诊断为永存原始玻璃体增生症(PHPV)111眼(97.4%),视网膜脱离3眼(2.6%)。术后明确病因为PHPV 76眼(66.7%),家族性渗出性玻璃体视网膜病变14眼(12.3%),先天性白内障24眼(21.0%)。69.3%患眼超声诊断与术后诊断一致。结论婴幼儿白内障合并玻璃体异常患儿就诊时月龄较大,多以家长发现白瞳就诊,可伴有多种眼部异常,术前眼部彩色多普勒超声检查有助于发现玻璃体视网膜病变。
[Abstract]:Objective to investigate the clinical features and etiology of cataract complicated with vitreous abnormality in infants. Design retrospective, non-controlled case study. Participants 84 cases (114 eyes) with cataract under 3 years of age were examined by color Doppler ultrasonography. Methods from January 2013 to July 2014, children under 3 years old with vitreous abnormality were treated by ophthalmology surgery in Beijing Tongren Hospital. The age, main complaint, signs, ultrasonic examination and ultrasonic diagnosis of children were recorded. The diagnosis, family history and maternal pregnancy history were determined. The etiology and clinical characteristics of cataract complicated with vitreous abnormality in infants were analyzed. Main outcome measures: age, symptoms, course of disease, signs, ultrasonic findings and ultrasonic diagnosis. Results in 84 cases (114 eyes), the age of onset was 0 ~ 15 months, mean (2.7 卤3.0) months, the age of diagnosis was 22 ~ 20 months, the average was (7.8 卤4.2) months, 81 cases (96.4%) were found abnormal by parents, 3 cases (3.6%) were found abnormal by physical examination. The main initial symptoms were white pupil in 39 cases (46.4%), non-recovery in 16 cases (19.0%), strabismus in 10 cases (11.9%), and unequal binocular size in 7 cases (8.3%). There were 75 eyes (65.8%) with total cataract, 38 eyes (33.3%) with posterior polar cataract, 1 eye (0.9%) with membranous cataract, which could be accompanied by nystagmus, strabismus, small eyeball, shallow anterior chamber, secondary glaucoma, pupillary remnant membrane, traction retinal detachment, choroidal defect and so on. (PHPV) was diagnosed by ultrasonography in 111 eyes (97.4%) and retinal detachment in 3 eyes (2.6%). The etiological factors were PHPV in 76 eyes (66.7%), familial exudative vitreoretinopathy in 14 eyes (12.3%), congenital cataract in 24 eyes (21.0%) and ultrasonic diagnosis in 69.3% eyes. Conclusion Children with cataract complicated with vitreous body abnormalities are older than those with abnormal vitreous body. Most of them are found white pupil by their parents, which can be accompanied by many kinds of ocular abnormalities. Preoperative color Doppler ultrasound examination is helpful to find vitreoretinopathy.
【作者单位】：首都医科大学附属北京同仁医院;北京同仁眼科中心
【基金】：首都临床特色应用研究(Z141107002514029) 首都医科大学眼科学院开放课题(201206)
【分类号】：R779.6

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